Healthcare Provider Details

I. General information

NPI: 1043817232
Provider Name (Legal Business Name): TEODULO JOSE PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3937 SW 25TH CT
CAPE CORAL FL
33914-5464
US

IV. Provider business mailing address

3937 SW 25TH CT
CAPE CORAL FL
33914-5464
US

V. Phone/Fax

Practice location:
  • Phone: 786-470-4563
  • Fax:
Mailing address:
  • Phone: 786-470-4563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11009441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: